Safety and efficacy of endovascular treatment for pediatric acute ischemic stroke: a systematic review and Meta-analysis

This meta-analysis aimed at evaluating the safety and efficacy of mechanical thrombectomy (MT) compared to the best medical management (BMM) in children after acute ischemic stroke. We conducted a systematic search of the literature through January 2025. Review Manager Software was used to calculate the odds ratios and their confidence intervals. The primary outcomes of interest were excellent functional recovery (modified Rankin Scale score ≤ 1 (PedmRS 0–1) at 90 days), symptomatic intracranial haemorrhage (sICH), and mortality. A total of eight studies encompassing 8048 patients were included. We found no statistically significant difference between the MT group and the BMM group in terms of mortality (OR 1.17, 95% CI [0.45, 3.05], p-value = 0.75, I2 = 0%), sICH (OR 1.32, 95% CI [0.40, 4.39], p-value = 0.6, I2 = 0%) and PedmRS 0–1 (OR 1.31, 95% CI [0.68, 2.53], p-value = 0.41, I2 = 43%). Furthermore, we performed a subgroup analysis of patients with large vessel occlusion (LVO) stroke and did not find any statistically significant difference between MT and BMM groups in terms of mortality (OR 3.48, 95% CI [0.42, 28.76], p-value = 0.25, I2 = 0%), sICH (1.09, 95% CI [0.26, 4.47], p-value = 0.90, I2 = 0%) and PedmRS 0–1 (OR 3.62, 95% CI [0.78, 16.76], p-value = 0.10, I2 = 59%). However, the BMM group showed increased odds of having a poor functional recovery (PedmRS 3–6) (OR 0.37, 95% CI [0.19, 0.73], p-value = 0.004, I2 = 0%). Our findings suggest that both MT and BMM have comparable safety and efficacy outcomes in the pediatric population. Further studies with more strict inclusion criteria are needed to confirm these findings. PROSPERO Registration: CRD42024609704.